How to restore the effectiveness of failed innovations

In any organisation, the drive for innovation is constant. But what happens when an innovative process doesn’t quite hit the mark or loses its effectiveness over time? Enter reimplementation: a strategy to rethink, tweak, and reintroduce processes within the organisational context. Here’s how Singapore General Hospital (SGH) breathed new life into its surgical safety checklist, with insights from our team at Ariadne Labs

CREDIT: This is an edited version of an article that originally appeared on Harvard Business Review

The decline of a once-promising tool

SGH adopted the World Health Organisation (WHO) Surgical Safety Checklist back in 2009, a tool praised for reducing surgical complications. Initially, it was a game-changer, even inspiring Atul Gawande’s book, The Checklist Manifesto. However, over the years, SGH found that their checklist’s effectiveness had waned. Audits showed that while checklists were being completed, they were often a box-ticking exercise rather than a meaningful safety tool.

Facing the challenges

Despite the checklist’s initial success, SGH encountered several issues. Staff engagement was lacking, communication faltered, and preventable harm incidents, though isolated, highlighted systemic vulnerabilities. It was clear that the checklist was no longer serving its purpose effectively.

Rethinking the process

SGH decided it was time for a change. Partnering with Ariadne Labs, they embarked on a mission to redesign and reimplement the checklist. Funded by Johnson & Johnson, the initiative aimed to foster a culture of safety and open communication.

Principles of successful reimplementation

1. Match challenges with existing innovations: Identify your organisation’s key problems and view existing innovations through this lens. SGH leaders realised the checklist had become a routine task, lacking genuine engagement. They opted to revamp the checklist rather than introducing a new process, ensuring it addressed the existing challenges.
2. Reimagine what’s possible: Reimplementation involves rethinking assumptions and expectations. At SGH, team hierarchy was a barrier to effective communication. The new checklist included conversation prompts and assigned sections to different team members, promoting ownership and communication.
3. Build momentum Creating support for reimplementation requires engagement and clear communication. SGH used training videos and transformed the checklist into a prominent poster in the operating room. These steps ensured everyone understood the new process and its importance.
4. Embrace vulnerability Leaders must be open about problems and willing to confront failures. At SGH, surgical leaders played a crucial role in championing the new checklist. Their transparency and commitment helped gain staff support, despite initial scepticism.

Making it work

SGH saw significant improvements post-reimplementation. Team performance, assessed using a validated observation scale, improved markedly. The culture around patient safety also saw gains in nine out of twelve areas, with reductions in surgical safety events and complications.

Innovative processes can lose their effectiveness over time, making it essential for organisations to reassess and reimplement as needed. By understanding the root causes of decline and making thoughtful adjustments, leaders can revitalise processes and achieve renewed success. SGH’s experience with their surgical safety checklist is a testament to the power of reimplementation done right.